Wisdom Teeth
What Are Wisdom Teeth?
A third molar, commonly called a wisdom tooth, is one of the three molars per quadrant of the human dentition. It is the most posterior of the three. The age at which wisdom teeth come through (erupt) is variable,but this generally occurs between late teens and early twenties. Most adults have four wisdom teeth, one in each of the four quadrants, but it is possible to have none, one to three, or more than four, in which case the extras are called supernumerary teeth.
Wisdom teeth may get stuck (impacted) against other teeth if there is not enough space for them to come through normally. Impacted wisdom teeth are still sometimes removed for orthodontic treatment, believing that they move the other teeth and cause crowding, though this is not held anymore as true. Impacted wisdom teeth may suffer from tooth decay if oral hygiene becomes more difficult. Wisdom teeth which are partially erupted through the gum may also cause inflammation and infection in the surrounding gum tissues, termed pericoronitis. Some more conservative treatments, such as operculectomies, may be fitting for some cases, yet impacted wisdom teeth are commonly extracted as treatment for these problems, many times before these problems even occur.
How Are Wisdom Teeth Removed?
The relative ease at which your dentist or oral surgeon can extract your wisdom teeth depends on their position and stage of development. Your oral health care provider will be able to give you an idea of what to expect during your pre-extraction exam. A wisdom tooth that is fully erupted through the gum can be extracted as easily as any other tooth. However, a wisdom tooth that is underneath the gums and embedded in the jawbone will require an incision into the gums and then removal of the portion of bone that lies over the tooth. Often, for a tooth in this situation, the tooth will be extracted in small sections rather than removed in one piece to minimize the amount of bone that needs to be removed to get the tooth out.
What Happens During Wisdom Teeth Removal?
Before your wisdom teeth are pulled, the teeth and the surrounding tissue will be numbed with a local anesthetic — the same type used to numb a tooth prior to having a cavity filled. In addition to the local anesthetic to numb the pain, you and your dentist or oral surgeon may decide that a sedative is desired to control any anxiety. Sedating medications that could be selected include: nitrous oxide (otherwise known as “laughing gas”), an oral sedative (for example, Valium), or an intravenous sedative (administered via an injection into your veins). If nitrous oxide is given, you will be able to drive yourself home. If any of the other medications is selected, you will need someone to drive you both to and from the appointment.
What Does Recovery Involve After Wisdom Teeth Are Pulled?
After having your wisdom teeth removed, the speed of your recovery depends on the degree of difficulty of the extraction (a simple extraction of a fully erupted tooth versus a tooth impacted into the jawbone).
In general, here’s what to expect.During the first 24 hours
first 24 hours
- Bleeding may occur for several hours after tooth extraction. To control it, position a piece of clean moist gauze over the empty tooth socket and bite down firmly. Apply constant pressure for about 45 minutes. A moistened tea bag is an effective alternative. The tannic acid in tea helps healing blood clots to form (blood clots function similarly to scab over an open wound). Repeat this process if a small degree of bleeding continues; if heavy bleeding continues to occur, contact your dentist or oral surgeon. Avoid rinsing or spitting for 24 hours after tooth extraction, avoid “sucking” actions (for example, don’t drink beverages through straws or smoke) and avoid hot liquids (such as coffee or soup). These activities can dislodge the clot, causing a dry socket (see below) to develop.
- Facial swelling in the area where the tooth was extracted typically occurs. To minimize swelling, place a piece of ice, wrapped in a cloth, on that area of your face on a schedule of 10 minutes on, followed by 20 minutes off. Repeat as necessary during this first 24-hour period.
- Pain medications, such as acetaminophen (Tylenol) or ibuprofen (Motrin or Advil), can be taken for minor pain. Your dentist or oral surgeon may prescribe more potent pain relievers, if necessary.
- Antibiotics that may have been prescribed prior to tooth extraction (to treat any active infection around the wisdom tooth to be extracted) should continue to be taken until the full prescription is gone.
- Foods should be restricted to a liquid diet until all the numbness from anesthesia has worn off. Eat soft foods for a few days. Also avoid alcohol if you’re also taking narcotic pain medication.
- Continue to brush your teeth, but avoid the teeth directly neighboring the extracted tooth during the first 24 hours. On day two, resume the gentle brushing of your teeth. Do not use commercial mouth rinses — these can irritate the extraction site.
After 24 hours
- Facial swelling in the area of the tooth extraction should be treated with heat after the first 24 hours of
ice. Apply a moist warm towel to the area on a 20-minute on, 20-minute off schedule. Repeat as necessary. Keep in mind that swelling usually peaks 2 to 3 days after the procedure. - Rinse your mouth with warm salt water (1/2 teaspoon of salt in a cup of warm water) after meals and before bed. Do not use commercial mouth rinses unless your dentist directs you to.
- Stitches, if used and if not of the self-dissolving type, need to be removed by your oral health care provider in about 1 week. If you do require stitches, ask what type you have been given.
- Watch for signs of dry socket (described below). This condition requires treatment by your oral health care provider.
- Complete healing doesn’t occur for a few weeks to a few months following the extraction. However, usually within the first week or two, enough healing has taken place for use of your mouth to be reasonably comfortable in the area of the extraction. Your dentist will explain what to expect in your specific case.
What Are Potential Complications of Wisdom Tooth Removal?
Two of the more important complications after having your wisdom teeth removed include:
Dry socket: Dry socket is a common complication that occurs when either a blood clot has failed to form in the extracted tooth socket or else the blood clot that did form has been dislodged. Without clot formation, healing will be delayed. When it happens, dry socket typically occurs 3 or 4 days following the extraction and is accompanied by pain (ranging from “dull” to moderate to severe) and a foul mouth odor. Your dentist or oral surgeon will treat the dry socket by placing medication in the socket.
Paresthesia: Paresthesia is a rarer complication of wisdom teeth extraction. Wisdom teeth entrapped in the jawbone are often close to nerves. Sometimes these nerves can be bruised or damaged during the tooth removal process. The result is a numbness (called a paresthesia) of the tongue, lip, or chin that can last a few days, weeks, months, or may even be permanent.
When Is Removal Needed?
When wisdom teeth cause problems, or X-rays show they might down the line, they need to come out. Other good reasons to take them out include:
Damage to other teeth: That extra set of molars can push your other teeth around, causing mouth pain and bite problems.
Jaw damage: Cysts can form around the new teeth. If they aren’t treated, they can hollow out your jaw and damage nerves.
Sinus Issues: Problems with wisdom teeth can lead to sinus pain, pressure, and congestion.
Inflamed Gums: Tissue around the area can swell and may be hard to clean.
Cavities: Swollen gums can create pockets between teeth that help bacteria grow and cavities form.
Alignment: Impacted wisdom teeth can cause problems with crowding of other teeth and even make treatment to straighten other teeth necessary.
Your dentist will look at the shape of your mouth and the position of your teeth to make a decision. Your age plays a role, too.